Spitz痣

<正>患儿男,6岁。主诉：右侧面部红色孤立结节6个月余。现病史：患儿6个月前无明显诱因右侧面部出现红色疣状丘疹,约绿豆大,无特殊不适,于当地医院就诊,诊断为寻常疣,予冷冻治疗2次,无明显改善。后皮损逐渐增大,遂于2021年1月6日来我院皮肤科就诊。既往史、个人史及家族史：患儿既往体健,家族中无类似疾病患者。体格检查：一般情况良好,各系统检查均正常。     

Spitz痣样黑素瘤

报告1例Spitz痣样黑素瘤。患者男,53岁,左前臂快速增大的无痛性皮肤结节3个月。皮肤科检查见左前臂直径0.8 cm的肤色半球形肿物,边界清楚,表面粗糙,上覆灰白色鳞屑,质韧。临床表现、组织病理及免疫组化检查结果均符合Spitz痣样黑色素瘤。行手术切除,术后未行其他治疗。术后9个月随访,未见复发及转移。     

发生在斑痣上的Spitz痣5例

报告5例发生在斑痣上的Spitz痣,其中1例位于下肢,4例位于面部.5例患者临床均表现为在斑痣上出现的红色或褐色丘疹,组织病理检查均为Spitz痣.     

成人Spitz痣1例

患者男,20岁.因鼻粱左侧结节半年余,于2008年11月24日就诊.患者于半年前发现鼻梁左侧有一棕红色丘疹.渐增大,无痛痒,未经过任何治疗.既往体健,家族成员中无类似疾病患者.     

多发性Spitz痣一例

患儿,男,5岁。8个月时左侧鼻部出现米粒大褐色丘疹,逐渐增大成为红褐色结节,类似皮疹于左侧面部不断发生,病理检查示：真表皮交界处及真皮内弥散性梭形痣细胞浸润,呈对称分布,痣细胞巢垂直于表皮。免疫组化示：Ki-67（〈2%-3%＋）,HMB45（＋）,S-100（＋）。     

播散性Spitz痣3例

Spitz痣又称梭形和上皮样细胞痣(spindle cell and epithelioid cell nevus),是一种后天发生的良性黑素细胞增生性疾病,在组织病理上容易与黑素瘤混淆.本病多发生于儿童和青少年的颜面部和四肢,通常表现为后天发生的单发丘疹.多发性Spitz痣较为罕见,根据其临床皮损形态和分布的不同又分为簇发性Spitz痣和播散性Spitz痣.现将笔者诊断的3例播散性Spitz痣临床及组织病理特点报告如下.     

节段分布的簇发型Spitz痣一例

患儿女,1岁.6个月时,左面部出现2～3个米粒大小红丘疹,无痛痒感.其后皮疹不断增多、增大.体检:左面部沿三叉神经上颌和下颌支部位呈节段性散在分布9个丘疹,米粒至绿豆大小,表面光滑,淡红色或棕红色.患儿发育、营养良好,各系统检查未见异常.     

斑痣、Spitz痣继发晕痣一例

患儿女,4岁,因右上臂皮疹2年余就诊。患儿2岁时右上臂屈侧出现浅褐色斑片,并逐渐于浅褐色斑片表面出现数个深褐色至黑色斑点及1个红色隆起性肿物。2个月后,于红色肿物周边开始出现白色晕环,但肿物颜色无变化。患儿无痒痛等不适症状。患儿自患病以来,全身其他部位皮肤未曾出现白斑。患儿家长疑虑恶变来我科就诊,要求手术治疗……     

Spitz痣25例临床病理分析

对2011-2017年西安交通大学第二附属医院的25例Spitz痣患者的临床及组织病理资料进行回顾性分析。25例患者中男11例,女14例,其中﹤10岁患者16例。皮损位于面部12例,下肢5例,上肢4例,躯干3例,头皮1例。皮损主要表现为扁平隆起或半球形,多有色素增加。84%的Spitz痣具有良性肿瘤的特点,16% Spitz痣结构不对称或境界不清楚。     

簇发性斯皮茨痣

报告1例簇发性斯皮茨(Spitz)痣(良性幼年黑素瘤)。患儿男,10岁。1年前左耳郭出现1枚小丘疹,曾在当地医院行手术将丘疹切除,术后2个月在手术切口周围出现数个丘疹,并逐渐增大,融合成斑片,部分皮损呈乳头瘤样。皮损组织病理学检查及免疫组化染色结果符合Spitz痣的组织病理学改变。结合临床及组织病理学改变,确诊为簇发性Spitz痣。     

Hyalinizing Spitz nevus

A seventeen-year-old Korean girl had a reddish-brown papular lesion on the nose. Histopathologically, it proved to be a "hyalinizing Spitz nevus" with the characteristic features of a discohesive growth pattern of nevus cells and hyalinized stroma. Immunohistochemical stains showed positive reactivity of nevus cells with S-100 protein and Vimentin and negative stainings with HMB45, CD68, CEA and low molecular weight cytokeratin. Hyalinizing Spitz nevus may represent a variant in the spectrum of Spitz nevus.     

A case of combined nevus: compound nevus and spindle cell Spitz nevus

Combined nevi consisting of a Spitz nevus and an acquired nevus are unusual, and, to our knowledge, the combination of a spindle cell Spitz nevus and an overlying compound nevus has not been previously reported. We report a 17-year-old girl with a nodule on the left anterior lower extremity. The nodule was asymptomatic, firm, brown, symmetrical, dome-shaped, 8 mm in diameter, and not found with ulceration. Histological findings showed proliferation of spindle-shaped cells with an overlying compound nevus. The spindle-shaped cells were large, non-pigmented, uniform in size and shape, with rare mitoses and without nuclear atypia, and arranged in a storiform pattern in thick collagen bundles. They stained positively for S-100 and negatively for HMB-45. The lesion was considered to be a new type of combined nevus consisting of a spindle cell Spitz nevus and an overlying compound nevus.     

Spitz nevus on the palmar surface

Relatively little is known about the incidence of Spitz nevus on palmar surfaces. This report places a case study in the context of the Japanese literature regarding the occurrence of Spitz nevus on palmar surfaces. Although the proportion of palms and soles in relation to the body surface is about 5%, the incidence of the Spitz nevus was 2%. The mean age at onset was 17.8 years, and all 4 cases were women. The clinical features were a black macule or flatly elevated small modules. The size of the lesions was relatively small, extending from 3.5 mm to 8.0 mm. Although the backs of the hands and insteps have almost the same area as the palms and soles, the incidence of onset in these regions was 6.3% (13 cases). We thus concluded that Spitz nevus tends to be rare on palms and soles.     

The local recurrence of pigmented Spitz nevus after removal

A seventeen-month-old female had a pigmented nodule on her left lower leg. The excised lesion was histologically diagnosed as a Spitz nevus, composed mainly of spindle-shaped melanocytes containing large amounts of melanin pigment. When nodular regrowth was seen at the operative site, the recurrent lesion was radically excised as nodular melanoma. However the histological characteristics of the second excised specimen were essentially the same as those in the initially excised one except for the existence of the newly formed collagen fibers, which may suggest an involuting stage in the central portion of the lesion.     

Pseudogranulomatous Spitz nevus: a variant of Spitz nevus with heavy inflammatory infiltrate mimicking a granulomatous dermatitis

Spitz nevus is a benign melanocytic proliferation that shows relatively characteristic clinicopathologic features. Despite this, Spitz nevus is clinically confused with many other lesions, and histopathologically it is sometimes difficult to distinguish it from melanoma. However, Spitz nevus rarely causes differential diagnostic problems with granulomatous dermatitis. This article describes an 8‐year‐old girl who presented with a nodule on her right arm, a clinical appearance of a pyogenic granuloma. Histopathologically, there was a dermal lesion composed of aggregates of large epithelioid cells surrounded by a heavy inflammatory infiltrate, mimicking a sarcoid‐like granulomatous dermatitis. Immunohistochemistry showed epithelioid cells with strong nuclear and cytoplasmic staining with S‐100 protein, thus establishing the diagnosis of a melanocytic tumor. The heavy T‐cell lymphocytic infiltrate that accompanies the large epithelioid cells caused its granulomatous appearance. Molecular assessment showed H27H mutation in the HRAS gene. We suggest the term ‘pseudogranulomatous’ for this variant of Spitz nevus because it indicates that the lesion is not authentically granulomatous and simply mimics a granulomatous dermatitis.     

斯皮茨痣16例临床及组织病理分析

目的：分析斯皮茨痣（Spitz nevus）的临床及组织病理特点。方法：采用回顾性分析对16例斯皮茨痣患者的临床及组织病理资料进行分析。结果：16例斯皮茨痣多发生于头面部和四肢,主要表现为黑色丘疹或斑疹,临床上容易误诊为色素痣。大部分斯皮茨痣具有良性肿瘤的特点,少数斯皮茨痣结构呈不对称性或细胞具有异形性,组织病理改变结合临床资料分析是诊断的关键。结论：表皮和附属器增生可作为斯皮茨痣与黑素瘤鉴别的依据之一,国人斯皮茨痣Kamino小体较少见。     

结缔组织增生性Spitz痣和色素性梭形细胞痣临床及组织病理学特征

目的:分析结缔组织增生性Spitz痣和色索性梭形细胞痣的临床及组织病理学特点.方法:回顾性分析确诊的8例结缔组织增生性Spitz痣和9例色素性梭形细胞痣患者的临床和组织病理学特征.结果:结缔组织增生性Spitz痣表现为梭形或上皮样痣细胞增生并伴有显著的胶原硬化和均质化,色素性梭形细胞痣表现为真、表皮交界处梭形细胞增生并伴有纤细的色素颗粒沉积.结论:结缔组织增生性Spitz痣和色素性梭形细胞痣是Spitz痣中较少见的特殊类型.其中色素性梭形细胞痣需要与黑素瘤相鉴别.